The Hidden Problem in Eczema Treatment For decades, topical corticosteroids (TCS) have been the go-to treatment for atopic dermatitis (AD), or eczema. They provide fast relief, reduce inflammation, and help control flare-ups. But what happens when long-term steroid use leads to more harm than good?
Many eczema sufferers find themselves trapped in a cycle of dependence, needing stronger steroids over time, only to face withdrawal symptoms when they try to stop. A 2023 Australian study found that 30% of AD patients experience steroid-related side effects (Patel et al., 2023). Breaking free from steroid reliance requires a new approach that focuses on barrier repair, non-steroidal treatments, and smarter eczema management.
Challenges of Steroid Reliance in AD Management A. Skin Barrier Damage & Thinning (Steroid-Induced Atrophy)
• Prolonged steroid use leads to thinning of the epidermis and dermis, making skin more fragile and prone to injury.
• Loss of collagen and elastin reduces skin’s ability to repair itself.
• Increased risk of bruising, telangiectasia (visible blood vessels), and delayed wound healing. B. Topical Steroid Withdrawal (TSW) Syndrome
•TSW is a severe rebound reaction that occurs when chronic steroid users discontinue treatment.
• Symptoms include red, burning, swollen skin, increased sensitivity, and “red sleeve syndrome” (a distinctive rash on arms and legs).
• Psychological impact is significant, with increased anxiety, depression, and sleep disturbances due to relentless itching.
• Studies suggest TSW is underdiagnosed and often mistaken for worsening AD (Liu et al., 2023). C. Systemic Absorption & Adrenal Suppression
• High-potency corticosteroids or prolonged use on large body areas can lead to systemic absorption.
• This can suppress the adrenal glands, leading to steroid withdrawal symptoms like fatigue, low blood pressure, and hormonal imbalances. D. Steroid Phobia vs. Steroid Overuse
• Some patients avoid steroids altogether (steroid phobia), leading to poorly controlled AD.
• Others overuse steroids, leading to dependence and resistance.
• Dermal clinicians play a key role in educating patients on safe steroid use and alternatives.
Alternatives to Long-Term Steroid Use in AD Given the risks of steroid dependence, dermal clinicians adopt a multimodal approach to AD management. The focus should be on barrier repair, immune modulation, and non-steroidal treatments.
Barrier-Enhancing Therapies
The Dark Side of Steroids: Why Overuse Is a Problem
One of the most concerning side effects of long-term steroid use is skin thinning and barrier damage. The skin becomes more fragile, sensitive, and prone to irritation. This can result in easy bruising, visible blood vessels (telangiectasia), and slow wound healing. Another significant issue is Topical Steroid Withdrawal (TSW), a condition that occurs when people suddenly stop using steroids after long-term application. Instead of the skin improving, it often worsens, leading to intense burning, itching, swelling, and the development of a rash, often called “red sleeve syndrome” due to its characteristic pattern on the arms and legs. Many people misinterpret TSW as a worsening of eczema, rather than a reaction to discontinuing steroids (Liu et al., 2023). Systemic side effects are also a risk, especially when high-potency steroids are used over large areas of the body. In some cases, the medication is absorbed into the bloodstream, leading to adrenal suppression, hormonal imbalances, fluctuations in blood sugar and blood pressure, and an increased risk of infections due to immune suppression. While steroids have their place in short-term eczema treatment, long-term reliance often creates more problems than solutions.
Managing Eczema Without Long-Term Steroid Use
There are now new treatment options that do not rely on steroids. Dermal clinicians play a crucial role in helping patients transition to better eczema management strategies that focus on skin barrier repair and non-steroidal therapies.
1. Strengthening the skin barrier is the first step:
Moisturising regularly with ceramide-based creams helps rebuild the skin’s protective layer, while urea-based formulations provide hydration and smooth rough patches such as our la pelle cleanser. Choosing our gel cleanser allows its pH-balance help avoid the consequences harsh soaps have in causing irritation. Ingredients such as niacinamide reduce inflammation and redness, while glycerin and hyaluronic acid boost hydration which is found in our la pelle barrier protect serum.
Lifestyle changes and environmental modifications:
can also play a key role in long-term eczema management. Wearing breathable, natural fabrics like cotton and bamboo helps reduce irritation, while hypoallergenic bedding minimizes exposure to dust mites. A Mediterranean-style diet rich in omega-3 fatty acids, probiotics, and antioxidants can help modulate the immune response and support skin health. Vitamin D supplementation has also been shown to improve eczema symptoms in some individuals.
For those experiencing TSW:
working closely with a dermal clinician to gradually taper off steroids and transition to alternative therapies can prevent severe withdrawal symptoms. Light emitting diode (phototherapy) with combining in treatment in clinic visits as well as using regularly from home the Nurture Me LED La Pelle Device (red/infrared), and other integrative approaches such as mindfulness and cognitive-behavioral therapy to provide additional relief and improve quality of life.
The Future of Eczema Treatment:
Steroid dependence has been a long-standing issue in eczema management, but with the rise of alternative treatments, patients now have more options than ever before. Dermal clinicians play a vital role in guiding patients through safer, long-term solutions that focus on strengthening the skin barrier, reducing inflammation, and improving overall skin health. By shifting the focus from steroid reliance to personalized treatment plans that integrate non-steroidal options, lifestyle modifications, and new biologic therapies, patients can achieve long-term relief and improved quality of life without the risks associated with prolonged steroid use.
Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice. Consult a qualified healthcare provider for personalised recommendations.
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